236 Views

830 - Functional Mutism Following Trauma Re-exposure: A Case Report

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

SF

Shane Fuentes, MD

Resident Physician
Mayo Clinic
Rochester, Minnesota, United States

Co-Author(s)

AR

Anish Rana, BA

Medical Student
University of Rochester Medical Center, Strong Memorial Hospital
Glen Mills, Pennsylvania, United States
JP

Jack Pettit, BS

Graduate Student
Georgetown University
Westfield, New Jersey, United States
HC

Heather M. Clark, PhD

Chair, Speech Pathology
Mayo Clinic - Rochester, MN
Rochester, Minnesota, United States
DS

Derek Stitt, MD

staff physician
Mayo Clinic
Rochester, Minnesota, United States

Case Diagnosis: Functional mutism.

Case Description: A 76-year-old female presented to the emergency department with sudden loss of speech upon waking. She drove herself to the hospital, where an initial stroke assessment was performed. The patient's last known well was the night before. A non-contrast head CT showed no abnormalities, and a subsequent MRI ruled out stroke. Upon further examination, the patient followed commands and communicated through writing. With significant effort and encouragement, she articulated the sounds "Puh," "Tuh," and "Kuh." Through written communication, the patient revealed that she spent the previous day in a psychotherapy session revisiting traumatic childhood events, including sexual assault. The history and clinical presentation were consistent with functional mutism. She was discharged with outpatient speech therapy the following day. At her first speech therapy session, the patient resumed normal oral language, but still had subtle dysphonia, dysfluency, and dysprosody. After two sessions of speech therapy, the patient’s speech returned to baseline.

Discussions: Distinguishing functional speech disorders from aphasia requires a thorough language assessment. Mutism with fully preserved written communication and verbal command comprehension is inconsistent with a lesion to the cerebral language networks. Functional speech disorders present with dysphonia, stuttering, slurring, or prosodic abnormalities, more often than mutism. Many individuals with functional speech disorders have a history of physical or psychosocial trauma, as in this patient who was recently re-exposed to childhood trauma. Treatment focuses on speech therapy, starting with education about functional disorders and its positive prognosis. Therapy aims to modify abnormal speech patterns to normal ones, with encouragement and praise for regaining control. Once patients recognize they have control over their speech, they often improve rapidly.

Conclusions: This case highlights the utility of a thorough language assessment to differentiate functional speech disorders from aphasia. It also emphasizes the critical role of early speech therapy in effectively treating these patients.